A Randomized Controlled Clinical Trail Of Acetate Ringers In Correcting Metabolic Acidosis In Hemorrhagic Shock Patients

Objective:Hemorrhagic shock is due to the rapid reduction of circulating blood volume and cardiac output which is caused by various reasons. The main pathological and physiological process is perfusion dysfunction of tissues and organs, ischemia and hypoxia, metabolism disorder of cells and dysfunction. If patients do not get timely treatment, a series of serious complications will happen and cause high mortality. The key to the success of the rescue is to improve the perfusion of the microcirculation of the tissues and organs, change the cell oxygen, prevent inflammation and correct acid-base imbalance at the time of effective hemostasis. Recovery liquids influence the effect of recovery directly, therefore the decision of which kind of recovery liquids should be selected is very important. Crystal solution is very important to maintain the internal environment during the resuscitation. Lactated ringers solution is used for resuscitation commonly. As it contains lactic acid, so lactic acid level will be increased, metabolism dysfunction of liver and kidney will be more serious and severe inflammatory will be caused.Therefor Lactated ringers is not suitable for correcting acid-base imbalance of the hemorrhagic shock patients,.Its clinical application is limited by a lot. Acetate ringers solution is a new type of Crystal solution,its p H and electrolyte composition are similar with the extracellular fluid of human body.It do not contain lactic acid, and the acetate in it can be metabolizd rapidly. It can improve the dysfunction of microcirculation rapidly. It has a great advantage to maintain internal environment. So acetate ringers solution is fitter for the early therapy of hemorrhagic shock.This study compared the clinical efficacy of acetate ringers solution and lactated ringers solution for correction of metabolic acidosis of hemorrhagic shock patients.MethodsFifty pationts of hemorrhagic shock were divid equally into 2 groups randomly(n=25): the acetate ringers solution(group A) and lactated ringers solution group(group L). Two groups of patients choose acetate ringers solution and lactated ringers solution as recovery liquid crystal respectively.Both of two groups infuse the volume of liquid according to the proportion of liquid crystal: colloid(hydroxyethyl starch injection) 200/0.5 = 1:1.Changes of arterial blood gas and volume of Na HCO3 before and 1,2,3,4h after induction respectively were observed.Result1. There were no statistics difference in the ASA grade,operation time,the volume of transfusion during operation and hemorrhage volume of both groups(P﹥0.05).2. p H in group A changed at time point of T3 compared to group L(P﹤0.05).Serum lactate level(LAC)decreased at T2 compared to T0 time in group A(P﹤0.05).LAC level increased at T2、T3、T4 compared to T0 time in group L(P﹤0.05).LAC level in group L increased at time point of T2、T3、T4 compared to group A(P﹤0.05).BE of the two groups respectively decreased at time points of T1、T2、T3、T4 compared to T0 time.There were no significant difference in the value of BE between the two groups. HCO3- of the two groups respectively decreased at time points of T1、T2、T3、T4 compared to T0 time.There were no significant difference in the value of HCO3- between the two groups.Volume of Na HCO3 in group A decreased compared to group L(P﹤0.05).ConclusionsBoth of acetate ringers solution and lactated ringers solution can achieve the purpose of correcting metabolic acidosis. Acetate ringers solution changes PH,decreases serum lactate level and decreases volume of Na HCO3 during fluid resuscitation in hemorrhagic shock. So acetate ringers solution is fitter for the early therapy of hemorrhagic shock than lactated ringers solution.